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The term ‘BRICS’ was coined to reflect a changing world, in which a number of large, emerging economies were starting to play a greater role in world economic affairs. Terms such as this reflect changing global realities, but also have the potential to shape those realities. The jury is still out on how far China’s ‘Belt and Road Initiative’ (BRI) will reshape the way we see the world. Our view is that it will have a significant impact in many areas, one of which is advancing cooperation for global health. At a time of retrenchment and reorientation in developed economies’ assistance, how China, existing donors and health agencies learn to work together will have an important impact on global health outcomes and may provide learning on how to collaborate on other, more contentious, issues.

Display of development ‘success’

Earlier this year, China hosted the Belt and Road Forum in Beijing, bringing together a broad range of countries and a substantial number of world leaders. This was a coming-out party for an idea that has been maturing since around 2013, when Xi Jinping, the Chinese President, started to reshape the country’s approach to external affairs. The scale of the ambition is impressive as China invests in global assets and finances a major infrastructure development initiative, which it hopes will mop up excess industrial capacity and develop markets as the domestic economy slows. It’s also a huge soft power play. Geographically, the continental ‘belt’ stretches through Central Asia to Europe, while the maritime ‘road’ winds from southern China round India and to the Mediterranean via parts of Africa.

A new set of global institutions, including the Asian Infrastructure Investment Bank (AIIB), and the New Development Bank, is being set up to channel much of the investment that China hopes will flow through these routes. While flows to date have been limited these are institutions with the potential to provide an alternative development architecture to the Bretton Woods institutions. It would be a mistake, though, to see this as just a cynical attempt to use up excess capacity and make new friends. China’s rapid economic development and huge rise in the population’s living standards is undeniable. Despite the problems created by this rapid development process, such as environmental degradation and wrenching social transformation, China’s geopolitical transformation comes as the Chinese leadership has increasing confidence in its track record and in the value of its development model for the world. China believes it has something to offer to the international development.

Transformations in China’s approach to global health

The breadth of the BRI means that many things can be brought under this umbrella. One of the ‘connectivities’ that underpin this initiative is increasing health cooperation, trade and assistance. Linked to this, China’s global health policy and engagement are being substantially transformed. Traditionally, China’s health assistance has been dominated by sending medical teams to developing countries, and donating medical facilities and drugs. Most such work has been carried out or overseen by provincial governments, twinned with recipient countries, and little in the way of systematic analysis has been carried out on the volumes or modalities of assistance. In recent years, though, global health has been moving up the policy agenda. The Healthy China 2030 plan, a high-level framework strategy, lists global health as a component of the country’s health work, and builds on recent commitments to an increased role in global health. Chinese debates show increasing confidence in the country’s achievements in at least certain areas of improving population health, and a belief that China has something to share with the world. The unveiling of a Chinese ‘acupuncture statue’ during the visit of Xi Jinping to Geneva in January for the signing of a memorandum of understanding with the World Health Organisation (WHO) on cooperation in BRI countries was a neat piece of soft power play, but also makes reference to something distinctly Chinese, further reinforcing the sense that China believes it has something to share.

And so to China’s second BRI coming-out party of 2017... In August, many of the great and the good of global health convened in Beijing for the Belt and Road High-Level Meeting for Health Cooperation, which culminated in the Beijing Communiqué, a declaration on health cooperation in BRI countries, whose signatories include heavyweight global health and multilateral agencies. The Communiqué is both a statement of principle of the need for cooperation for health and development in an interconnected world, and of the areas in which China hopes to partner with the world. Main focus areas are tackling infectious diseases, promoting maternal and child and reproductive health, promoting traditional medicines, increasing R&D and innovation in health sciences and technologies, some health systems strengthening, and policy research and health industry cooperation. The themes and priorities build on a BRI health strategy issued by the National Health and Family Planning Committee, China’s health ministry, in 2015, but have been substantially developed and show much greater maturity. The focus areas also link back to China’s own experience and preoccupations, including a concern with infectious diseases such SARS and, subsequently, Avian Influenza, which are likely to become more prominent in a world of increasing connectivity (including connectivity driven by the BRI itself). In this sense, the Communiqué reflects a process of self-reflection as China starts to define its potential role (and interests) in global health.

Towards collaboration for global public good

To date, many debates regarding the BRI have focused on potential resource flows. Inevitably, at a time of shrinking aid budgets in many advanced economies, the disengagement of the US from many collaborative endeavours, including in global health, and under-funding of the WHO, it is tempting to see China’s potential role principally as a financier – to see the country as a rising power with deep pockets and money to spend to buy goodwill. While China’s capacity to engage globally, including its capacity to carry out health cooperation, is not comparable to that of mature donors or major multilateral agencies, and few Chinese researchers or officials have experience of on-the-ground work elsewhere, it would be a mistake to think that China will be a disinterested donor. From what we can see emerging, we should expect to see the country promoting its own developmental and technical contribution in areas where it thinks it has something to offer. The emergence of such a development actor will require accommodation on the part of other donors and development agencies, and a process of learning to work together. The aim has to be collaboration for the global public good. Health will be an important component, but learning will be required in other sectors, and there’s a need to build capacity for mutual learning. That learning should start now.

Lewis Husain and Gerry Bloom are engaged in the evaluation of the China-UK Global Health Support Programme, funded by the UK Department for International Development. Read their recent briefing on China’s changing global health commitments.